"No conceivable injury to life, limb or property could emerge from the test that has been made at Woomera... conducted in the vast spaces in the centre of Australia... with all our natural advantages for the purposes."
At the Hurricane trial Australian scientists did not have sufficient information to advise the Australian government whether the weapon could be fired in conditions which would represent no hazard to the Australian mainland.
The Australian government was placed in a position where it was forced to accept UK assurances on the safety aspects of the test without any critical examination by its own scientists.
There was virtually complete government control of the Australian media reporting the Hurricane test and the lead up to it, thus ensuring that the Australian news media reported only what the UK government wished.
The decision to use the mainland for atomic tests was made without specific consideration by Australian scientists or others of whether weapons could be safely fired. Consideration was limited to the fact that Emu was a remote location.
Information available to Australian scientists on the movement and location of people in the vicinity of Emu was inadequate.
The establishment of the atomic weapons safety committee [AWTSC -- referred to in the text as the Australian safety committee] was an important, albeit tardy, step in providing the Australian government with the opportunity to obtain independent scientific advise on the safety aspects of the tests.
Although the AWTSC was established by the time of Mosaic and had an effective power of veto, it was not provided with sufficient information to discharge its function properly for the Mosaic tests.
The Australian government had sufficient information to make an informed decision as to the criteria for safe firing for the Buffalo tests.
Significantly greater attempts were made to inform the public about the Buffalo testing program with a view to allaying public concerns about safety. The public was not, however, informed of the true nature of the hazards involved.
The AWTSC was provided with adequate information was was able to properly advise the government about the safety of the proposed Antler tests.
The Australian government had sufficient information to make an informed decision as to the criteria for safe firing of the Antler tests.
The AWTSC failed to carry out many of its tasks in a proper manner. At times it was deceitful and allowed unsafe firing to occur. It deviated from its proper charter by assuming responsibilities which properly belonged to the Australian government.
Titterton played a political as well as safety role in the testing program, especially in the minor trials. He was prepared to conceal information from the Australian government and his fellow [safety] committee members if he believed to do so would suit the interests of the United Kingdom government and the testing program.
The fact that the AWTSC did not negotiate with the UK openly and independently in relation to the minor trials was a result of the special relationship which enabled Titterton to deal with the atomic weapons research establishment [AWRE -- referred to in the text as Aldermaston] in a personal and informal manner. He was from first to last 'their man' and the concerns which were ultimately voiced in relation to the Vixen B proposals and which forced the introduction of more formal procedures for approving minor trials were a direct result of the perceived inadequacies in the manner in which he had carried out his tasks.
There were departures, some serious and some minor, from compliance with the prescribed radiation protection policy and standards during the test program.
The measures taken before and at the time of the tests for protecting persons against exposure to the harmful effects of radiation, based as they were on the concept that any dose below a certain threshold was 'safe', must be regarded as inadequate in the light of radiation protection standards at the present time.
By reason of the detonation of the major trials and the deposition of fallout across Australia, it is probable that cancers which would not otherwise have occurred have been caused in the Australian population.
Their exposure to radiation as participants in the trial program has increased the risk of cancer among 'nuclear veterans'.
The royal commission has been unable to quantify the probable increase in the risk of cancer among the participants in the trial program or among the Australian population in general.
There was fallout on the mainland following Hurricane, although most of the activity fell in the sea to the north and west, as was intended. The fallout probably did not begin falling on the mainland until 30 hours after the burst. Hence it is unlikely that the fallout exceeded the no risk level proposed in the report prepared prior to the test.
There was a failure at the Hurricane trial to consider the distinctive lifestyles of the Aboriginal people. As no record was made of any contamination of the mainland it is impossible to determine whether Aborigines were exposed to any significant short or long-term hazards.
Air crew of the [RAAF] Lincoln aircraft at Hurricane should have been supplied with radiation monitoring devices and given instructions as to their behaviour when in the cloud or a contaminated aircraft. The failure to provide this equipment and instructions was negligent. Ground crew should have been similarly equipped and instructed.
The failure to make provision for personal monitoring of air and ground crews was an omission which fortuitously did not result in exposure of those personnel to high levels of radioactivity. The RAAF should have been informed of the risks and provided with equipment to monitor the crews.
The royal commission finds convincing the recurring evidence given by servicemen who were at the Hurricane test in positions close to the site of the explosion that after a person had entered an active area decontamination procedures were tediously and thoroughly carried out.
The firing criteria used for the Totem One test ignored some of the recommendations of Report A32 and did not take into account the existence of people at Wallatinna and Welbourn Hill down-wind of the test site.
The weather conditions at the time of the firing of Totem Two satisfied the criteria for firing.
There was a failure at the Totem trials to consider adequately the distinctive lifestyle of Aborigines and, as a consequence, their special vulnerability to radioactive fallout.
Meteorological, mathematical and statistical modelling indicates that a black mist passing over Wallatinna and Welbourn Hill could have happened.
There is no reason to disbelieve Aboriginal accounts that the Black Mist occurred and that is made some people sick. Both radiation exposure and fear can lead to vomiting. At Wallatinna, the vomiting by Aborigines may have resulted from radiation, it may have been a psychogenic reaction to a frightening experience, or it may have resulted from both of these.
The royal commission believes that Aboriginal people experience radioactive fallout from Totem One in the form of a black mist or cloud at and near Wallatinna. This may have made some people temporarily ill. The royal commission does not have sufficient evidence to say whether or not it caused other illnesses or injuries.
Given the historical uncertainties and the current state of scientific knowledge, the evidence presented does not enable the royal commission to decide one way or the other whether the Black Mist caused or contributed to the blindness of Yami Lester.
Radiological safety procedures at Emu, including decontamination, were well planned and executed. The royal commission cannot exclude the possibility that some unplanned incidents occurred, including the loosening or removal of respirators by participants in the forward areas.
It was negligent to allow aircrew to fly through the Totem One cloud without proper instructions and without protective clothing.
Aircrew of Lincoln aircraft at Totem One should have been supplied with radiation monitoring devices and given instructions as to the behaviour of these devices when in the cloud or a contaminated aircraft. The failure to provide this equipment or these instructions was negligent. Ground crew should have been similarly equipped and instructed.
The Mosaic tests were conducted in a hurry under marginal meteorological conditions.
The theoretical predictions were incorrect for both Mosaic tests and parts of the clouds passed over the mainland of Aus.
The AWTSC [Australian safety committee] report to the prime minister following the Mosaic tests was misleading and did not properly inform the government of the difficulties experienced with meeting the firing criteria, the unexpected winds that brought some of the stem and cloud over the mainland and the higher than expected levels of fallout on the mainland.
For the chairman of the AWTSC to advise the minister for supply that conditions for the firing G2 were ideal from the point of view of safety of the mainland was grossly misleading and irresponsible.
The presence of Aborigines on the mainland near the Monte Bello Islands and their extra vulnerability to the effect of fallout was not recognised by either AWRE [Aldermaston] or the safety committee. It was a major oversight that the question of acceptable dose levels for Aborigines was recognised as a problem at Maralinga but was ignored in setting the fallout criteria for the Mosaic tests.
The royal commission concludes that the precautions taken for the health and safety of the servicemen at Mosaic were generally adequate.
Round 2 (Marcoo) was fired in conditions which violated the firing criteria that there should be no forecast of rain except in areas remote -- interpreted as 500 miles (800 km) from ground zero. Rain was forecast within 250 miles (400 km) and actually fell within 100 miles (160 km) of ground zero.
Round 3 (Kite) was fired under conditions which led to contamination of Maralinga village. Although, in the event, the contamination was minor, the round should not have been fired under the conditions prevailing at the time.
Round 4 (Breakaway) was fired under conditions for which the fallout was predicted to exceed Level A beyond a distance of 100 miles (160 km) and into the inhabited region. In addition, the condition that there should be no overlap of fallout exceeding the Level A at distances more than 100 miles (160 km) from the site was violated.
Overall, the attempts to ensure Aboriginal safety during the Buffalo series demonstrate ignorance, incompetence and cynicism on the part of those responsible for safety. The inescapable conclusion is that if Aborigines were not injured or killed as a result of the explosion, this was a matter of luck rather than adequate organisation, management and resources allocated to ensuring safety.
The Pom Pom incident demonstrated that flaws existed in the security system at Maralinga. Those responsible for security seemed at least as concerned about the exposure of such flaws as the welfare of the Milpuddie family.
For the Milpuddies the experience caused great concern and it distresses Edie Milpuddie today. The royal commission cannot exclude the possibility that the Milpuddies' entry into the contaminated area resulted in injury to them.
Radiological and physical safety arrangements for participants during the Buffalo tests were well planned and sound. Security was strictly policed during the major tests but was relaxed afterwards. Unplanned incidents and exposures may have occurred during this time. Breeches of safety regulations may also have occurred when participants loosened or discarded respirators.
Operation of the 'need to know' principle and the minimal amount of information given to participants has been a factor contributing to participants' concerns and fears regarding what might have resulted from their experiences at Maralinga. Nevertheless, such participation at the tests, including residence in the village during the Kite explosion, has increased the risk of cancer to those participants who were exposed to radiation by the royal commission has been unable to quantify the probable increase.
The royal commission rejects the allegation that mentally defective people were used in nuclear experiments at the Buffalo tests.
Inadequate attention was paid to Aboriginal safety during the Antler tests. People continued to inhabit the prohibited zone as close to the test sites as 130 km.
Air and ground patrols for Antler were neither well planned nor well executed.
The Antler series of tests was clearly better planned, organised and documented than any of the previous test series. Nevertheless, it was not entirely without unplanned incident.
The procedures adopted for the decontamination of aircraft at Mosaic, Buffalo and Antler were, for the most part, well developed and managed.
The weapon exploded at Tadje had associated with it cobalt 60 to be used as a tracer. The technique used proved to be unsuccessful and the resultant dispersal of the active pellets was only discovered accidentally many months after the explosion.
The Australian health physics representative (AHPR) and those personnel who helped collect the pellets for subsequent disposal were exposed to radiation as a result.
The British scientists should, as had been agreed, have informed the AHPR of the existence of the pellets, before they left the range at the end of the Antler series. By their failure to do so, an unnecessary radiation hazard was created.
The royal commission believes that Titterton was the only member of the [Australian safety committee] who knew of the use of cobalt 60 at the time of the Tadje test. In not informing other members of the [safety committee] and the AHPR, he also contributed to an unnecessary radiation hazard.
Operation Brumby was based on wrong assumptions. It was planned in haste to meet political deadlines and, in some cases, the tasks undertaken made the ultimate clean up of the range more difficult.
The Maralinga range is not acceptable in its present condition and it must be cleaned up.
The aim of the clean-up should be to allow Aborigines access to the test sites without restriction.
The hazard from radiation at the [bomb trial] ground zeros is not excessive. The concrete plinths with their warning messages are an adequate indication to people not to camp permanently at these sites. The level of radiation will decay to one of no significance during the lifetime of the younger people now returning to the area.
The most significant hazard to Aborigines using the test sites is from the plutonium contamination. The hazard from the inhalation of dust raised by winds appears to be acceptable. However, three other pathways -- inhalation by children digging and playing, ingestion through bush foods and injection of plutonium -- do produce unacceptable levels of risk. From the range of estimates of the level of this risk in the evidence tendered to the royal commission, it is clear that more information is needed on the possible Aboriginal lifestyles in the area, the dust conditions in Aboriginal camps, the types and amounts of specific food items and the amounts of plutonium in these foods items. Information on the particle size distribution of plutonium contamination is also very important and needs to be determined.
The plutonium-contaminated areas must be cleaned up. However, more work is needed to develop realistic hazard assessments so that criteria can be derived for the clean up otherwise it is impossible to specify what areas must be cleaned, to what depth and to what level of residual contamination.
The pits containing plutonium waste at Taranaki and TM101 must be treated by either immobilising the plutonium in the debris or by removing the material from the pits.
Various options for clean-up were considered by the royal commission has not been able to make detailed recommendations because insufficient data were tendered on the levels of risk, options for clean-up and the associated costs. Nevertheless, the royal commission would suggest that any clean-up should include additional fencing in the short term, an emu parade to collect plutonium-contaminated fragments, the removal and burial of the plutonium-contaminated soil at Taranaki and action to immobilise or exhume the waste pits at Taranaki.
The traditional owners of the Maralinga lands were denied effective access to these lands for over 30 years as a result of the British nuclear test program. This denial has contributed to their emotional, social and material distress and deprivation.
The royal commission concludes that responsibility for compensation to those people who have been denied use of their lands because of the nuclear test program should be assumed by the Commonwealth government.
The cost of the clean-up of the Maralinga range should be borne by the UK government because the previous clean-up in 1968 was clearly inadequate and based on insufficient information.
AIRAC with on exception spoke only to person with an interest in advancing the view that safety measures taken were adequate and effective. This had led to an apparent bias in the material before it. As a consequence the report cannot be described as an objective and impartial assessment of the situation.
Because of the paucity of relevant information on which it is based, the Donovan report cannot be regarded as an adequate epidemiological study of the health of atomic test personnel.
Because of the deficiencies in the available data, there is little prospect of carrying out any worthwhile epidemiological study of those involved in the tests nor of other who might have been directly affected by them.